Head and Neck Cancers
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Head and neck cancers are malignancies arising in the upper aerodigestive tract (this includes: lip, tongue, salivary glands, mouth, oropharynx, nasopharynx, hypopharynx, nasal cavity, and larynx). Laryngeal (voice-box) cancer is the most frequent type, accounting for about a quarter of head and neck cancers.

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Laryngeal Cancer
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Molecular Biology of Head and Neck Cancers
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Latest Research Publications

Head and Neck Cacer Resources (16 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Wang F, Li S, Wang L, et al.
DATS suppresses growth of esophageal squamous cell carcinoma by regulation of ERK1/2.
Clin Lab. 2015; 61(3-4):315-22 [PubMed] Related Publications
BACKGROUND: It is well known that garlics contain a large number of organosulfur compounds including diallyl trisulfide (DATS), which possess anticancer properties. However, the effects of DATS on esophageal squamous cell carcinoma (ESCC) growth are still poorly understood. In this study, we investigated the effects of DATS on ESCC cell growth in vivo and in vitro, as well as the associated signaling pathways.
METHODS: Cell proliferation was measured using the crystal violet assay. The transwell method was used to evaluate the effect of DATS on ESCC cell migration. Also, Western blot was performed to detect the activation of ERK1/2 and AKT1 responds to DATS. Finally, the effect of DATS on ESCC xenografts in nude mice was also investigated.
RESULTS: Our results showed that DATS significantly inhibited ESCC cell proliferation in a time- and dose-dependent manner. DATS time-dependently (p < 0.05) increased phosphorylation of ERK1/2, but not AKT1. Suppression of ERK1/2 activation with PD9805 also completely blocked DATS-inhibited ESCC cell proliferation. Meanwhile, DATS also robustly suppressed ESCC xenograft growth and increased ERK1/2 activation in nude mice.
CONCLUSIONS: Our finding demonstrated that DATS inhibits the proliferation of ESCC cells by activation of ERK1/2 in vitro and in vivo. These findings revealed that DATS could be used for therapeutic intervention for human ESCC.

Related: Cancer of the Esophagus Esophageal Cancer AKT1

Lapthanasupkul P, Juengsomjit R, Klanrit P, et al.
Oral and maxillofacial lesions in a Thai pediatric population: a retrospective review from two dental schools.
J Med Assoc Thai. 2015; 98(3):291-7 [PubMed] Related Publications
OBJECTIVE: To determine the prevalence of oral and maxillofacial lesions in a Thai pediatric population.
MATERIAL AND METHOD: Oral biopsy records from pediatric patients between the ages of 0 and 15 years in the files ofFaculty of Dentistry, Mahidol University, and the files of Faculty of Dentistry, Khon Kaen University were reviewed. The patients were divided into three age groups, including 0 to 5, 6 to 10, and 11 to 15 years. Excluding the diagnosis of normal tissues, the oral and maxillofacial lesions were classified into nine categories.
RESULTS: Of 13,050 biopsied oral and maxillofacial lesions, 1,389 cases (10.6%) came from pediatric patients. The largest number of lesions was odontogenic cysts and tumors, followed by inflammatory and reactive lesions, and salivary gland pathology The top ten most prevalent lesions contributed 73% of all oral biopsies. The most common lesion was dentigerous cyst, followed by mucocele and pyogenic granuloma.
CONCLUSION: The vast majority of oral diseases in children were benign and related to either developmental or tissue reaction, while malignant lesions were found in a very small proportion of all oral biopsies.

Related: Oral Cancer Thailand

Khaimook W, Plodpai Y
Malignant tumors of temporal bone in Songklanagarind Hospital: management and results.
J Med Assoc Thai. 2015; 98(3):273-8 [PubMed] Related Publications
OBJECTIVE: To evaluate the clinical course and treatment in patients with carcinoma of temporal bone
MATERIAL AND METHOD: The authors retrospectively reviewed the patients treated for primary carcinoma of temporal bone in Otolaryngology Head and Neck Surgery department, at Songklanagarind Hospital between 2002 and 2013. Thirty-two patients, including 10 cancer ofpinna and 22 carcinoma of the External Auditory Canal (EAC), were included in this study. The treatment modality was lateral temporal bone resection and postoperative radiotherapy and palliative radiotherapy for advanced stage tumors (T4). Twelve patients were excluded due to difference in modality. Twenty patients remained in the study.
RESULTS: Twenty patients had carcinoma of EAC, early stage (T1, T2) 36.4% and late stage (T3, T4) 63.6%. The overall survival of this group was 46.9%. The median survival period was 22 months (0.286-0.769, 95% CI).
CONCLUSION: The complete resection is the treatment of choice in primary cancer of temporal bone. Postoperative radiotherapy for a microscopic residual tumor is highly recommended. The most important thing is early diagnosis.

Ren X, Zhao Z, Huang W, et al.
Analysis of the characteristics and factors influencing lymph node metastasis in thoracic esophageal carcinoma and cancer of the gastric cardia.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):73-6 [PubMed] Related Publications
BACKGROUND/AIMS: To analyze the metastatic characteristics of lymph nodes in thoracic esophageal carcinoma and cancer of the gastric cardia, and to explore the factors influencing lymph node metastasis.
METHODOLOGY: A retrospective analysis of the treatment of 37 patients who received surgical treatment for thoracic esophageal and gastric cardia cancers from January 2010 to January 2012 was carried out,
RESULTS: Lymph node metastasis in patients with thoracic esophageal carcinoma was frequently found on the superior mediastinum, hilum of the lung, and inferior extremity of the carina. Metastasis in patients with cancer of the gastric cardia occurred mainly in the abdominal cavity and peripheral gastric cardia. A single factor analysis showed that a tumor infiltrating full-thickness, > 5 cm in length, and with a low degree of cell differentiation affected lymph node metastasis (P < 0.05). The degree of differentiation, length, and infiltrating depth of the tumor were independent factors affecting lymph node metastasis (P < 0.05).
CONCLUSIONS: Lymph node metastasis in patients with cancers of the esophagus and gastric cardia exhibits special characteristics. The cleaning scope should be assessed according to the actual situation, including the degree of tumor differentiation, lesion length, and infiltration depth.

Related: Cancer of the Esophagus Esophageal Cancer Stomach Cancer Gastric Cancer

Kawasaki K, Oshikiri T, Kanaji S, et al.
Thoracoscopic esophagectomy in prone position: advantages of five ports over four ports.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):69-72 [PubMed] Related Publications
BACKGROUND/AIMS: Thoracoscopic esophagectomy in the prone position (ThE-PP) is usually performed with four ports, which makes the operation almost solo surgery. We now perform ThE-PP with five ports, with the advantage of having the assistant able to provide additional help. The aim of this study was to elucidate the benefits of ThE with five ports over ThE with four ports.
METHODOLOGY: We retrospectively reviewed the clinical charts of 47 patients with esophageal cancer who underwent ThE-PP. A total of 14 patients underwent ThE-PP with four ports and 33 with five ports. We compared the number of dissected lymph nodes (LNs)--total; upper left, middle, and lower mediastinum--between the four-port and five-port groups.
RESULTS: The number of LNs dissected, including the total, the upper left and middle mediastinum, were not significantly different between the two operations. The number of LNs dissected from the lower mediastinum, however, was significantly higher in the five-port group (median number and interquartile range: 5 and 2-7, respectively) than in the four-port group (0.5 and 0-3, respectively) (P < 0.01).
CONCLUSIONS: ThE-PP performed with five ports has an advantage over the same operation done with four ports in terms of lymphadenectomy in the lower mediastinum.

Related: Cancer of the Esophagus Esophageal Cancer

Ye LP, Zhu LH, Zhou XB, et al.
Endoscopic excavation for the treatment of small esophageal subepithelial tumors originating from the muscularis propria.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):65-8 [PubMed] Related Publications
BACKGROUND/AIMS: This study was designed to evaluate the safety and efficacy of endoscopic excavation for esophageal subepithelial tumors originating from the muscularis propria.
METHODOLOGY: Forty-five patients with esophageal subepithelial tumors originating from the muscularis propria were treated with endoscopic excavation between January 2010 and June 2012. The key steps were: (1) making several dots around the tumor; (2) incising the mucosa along with the marker dots, and then seperating the tumor from the muscularis propria by using a hook knife or an insulated-tip knife; (3) closing the artificial ulcer with clips after the tumor was removed.
RESULTS: The mean tumor diameter was 1.1 ± 0.6 cm. Endoscopic excavation was successfully performed in 43 out of 45 cases (95.6%), the other 2 cases were ligated with nylon rope. During the procedure perforation occurred in 4 (8.9%) patients, who recovered after conservative treatment. No massive bleeding or delayed bleeding occurred. Histologic diagnosis was obtained from 43 (95.6%) patients. Pathological diagnoses of these tumors were leiomyomas (38/43) and gastrointestinal stromal tumors (5/43).
CONCLUSIONS: Endoscopic excavation is a safe and effective method for the treatment of small esophageal subepithelial tumors originating from the muscularis propria.

Related: Cancer of the Esophagus Esophageal Cancer Gastrointestinal Stromal Tumors

Williams L, Thompson LD, Seethala RR, et al.
Salivary duct carcinoma: the predominance of apocrine morphology, prevalence of histologic variants, and androgen receptor expression.
Am J Surg Pathol. 2015; 39(5):705-13 [PubMed] Related Publications
Salivary duct carcinoma (SDC) is a prototypic aggressive salivary gland carcinoma. Our aim is to determine the prevalence of histologic variants (micropapillary, basal-like) and androgen receptor (AR) expression in a large multi-institutional series of SDC. AR status was determined by immunohistochemistry (IHC). Most SDCs were characterized by an apocrine phenotype and AR expression. Cases with a nonapocrine phenotype and AR-negative status were studied by additional IHC and fluorescence in situ hybridization for ETV6 or MYB/NFIB. The diagnosis of SDC was confirmed in 187 of 199 (94%) cases. Variant morphologies were identified in 12 cases: micropapillary (n=6), sarcomatoid (n=3), mucinous (n=2), and basal-like (n=1). AR IHC was performed in 183 cases, of which 179 (97.8%) showed AR expression. On the basis of morphologic appearance and results of additional studies, 12 cases were reclassified as squamous cell carcinoma (SCC) (n=4), epithelial-myoepithelial carcinoma with high-grade transformation (HGT) (n=2), myoepithelial carcinoma (n=2), mammary analogue secretory carcinoma, high grade (ETV6 translocated; n=1), adenoid cystic carcinoma with HGT (n=1), acinic cell carcinoma with HGT (n=1), and adenosquamous carcinoma (n=1). AR-negative SDC is extremely rare, and the majority of such cases are more accurately classified as other entities. HGTs of other salivary carcinomas and squamous cell carcinoma are the most common mimics of SDC. SDCs with variant morphologies still show at least a minor component of conventional apocrine appearance. Thus, apocrine morphology defines SDC.

Related: FISH Salivary Gland Cancer AR: androgen receptor

Başyiğit I, Boyaci H, Uçar EK, et al.
Tongue carcinoma with endobronchial metastasis: a rare case.
Acta Clin Croat. 2014; 53(4):483-6 [PubMed] Related Publications
Endobronchial metastases of extrapulmonary malignant tumors are quite rare. We present a patient with endobronchial metastasis previously operated for tongue carcinoma. A 71-year-old female patient presented with the complaint of cough. She had a history of tongue carcinoma operation 2 years before. Chest x-ray revealed an air-fluid level in the lower zone of the right hemithorax. There was a big cavitary lesion in the right lower lobe and bilateral multiple nodular lesions, some of which had cavity formation on computed tomography. Bronchoscopy re- vealed a polypoid lesion with necrotic appearance and pathologic examination showed squamous cell carcinoma. The lesion was accepted as a metastasis of tongue carcinoma after evaluation of the materials taken from the tongue on previous operation. There was no finding suggestive of local recurrence; however, the patient died from hemoptysis and respiratory insufficiency. In conclusion, endobronchial metastasis should be considered in patients with extrapulmonary malignancies and bronchoscopic examination should be performed in such cases, even in the presence of atypical radiological findings.

Rocca BJ, Barone A, Ginori A, et al.
Unusual presentation of metastatic adenoid cystic carcinoma: a challenge in aspiration cytology of the thyroid.
Pathologica. 2014; 106(4):342-4 [PubMed] Related Publications
INTRODUCTION: Adenoid cystic carcinoma is a malignant neoplasm most commonly originating in the salivary glands. Its occurrence elsewhere is rare and its metastasis to the thyroid gland has been described only once.
CASE REPORT: We describe the case of a 66-year-old man who presented for a swelling in the midline neck of six months duration. A solitary palpable nodule was identified in the isthmic region of the thyroid. Fine needle aspiration of the nodule revealed high cellularity, a partial microfollicle-like pattern and the presence of small hyaline globules. The neoplastic population was composed of monomorphic cells with basaloid appearance. Thyroid primitivity was excluded on the basis of the negativity for TTF1 and thyroglobulin. As the patient referred an ulcerative lesion of the inferior lip, fine needle aspiration cytology of the lesion was performed, yielding a diagnosis of adenoid cystic carcinoma.
CONCLUSION: The present case highlights the need to be aware of possible metastatic thyroid localisation of adenoid cystic carcinoma also originating in minor salivary glands of the oral cavity. This is a very rare event, but it should be taken into consideration and clinical and cytological findings must be carefully examined.

Related: Salivary Gland Cancer

Kucuk U, Pala EE, Bayol U, et al.
Huge congenital haemangioma of the tongue.
J Pak Med Assoc. 2014; 64(12):1415-6 [PubMed] Related Publications
Haemangiomas, the most common type of benign vascular tumours, are rare in the oral cavity. Some of these lesions are congenital and show symptoms in late childhood or early adult life. A 32-years-old woman presented with a huge lesion on her tongue which caused dysphagia and dysphasia. She had first noticed the lesion when she was 6. Her obstructive symptoms started when she was 28 and, despite various medical treatments, the size of the lesion gradually increased. Magnetic resonance imaging revealed a 7 x 5 x 3 cm mass on the right side of the tongue. Because of severe functional and cosmetic problems, the lesion was excised with partial haemiglossectomy. Histopathological examination was consistent with intramuscular haemangioma. Haemangiomas are benign tumours with a benign course and are rarely seen on the tongue. They have clinical importance when localised in the oral cavity. Different treatment modalities exist, but in cases of large tumours, surgery may be the mainstay treatment.

Dong YN, Zhang L, Sun N, et al.
Novel T-shaped linear-stapled intrathoracic esophagogastric anastomosis for minimally invasive Ivor Lewis esophagectomy.
Ann Thorac Surg. 2015; 99(4):1459-63 [PubMed] Related Publications
We report a novel T-shaped linear-stapled intrathoracic esophagogastric anastomosis for minimally invasive Ivor Lewis esophagectomy. A unique feature of this technique is a "gastric pouch" that is preserved proximal to the gastric conduit and which serves as the stapler-firing pathway to protect the gastric conduit. The linear stapler is placed through an auxiliary port in the seventh intercostal space on the right posterior axillary line and fired along the longitudinal axis of the thorax, without being constrained by limited intrathoracic space. This technique, which has been performed in 8 patients, is efficient, reliable, and easy to perform.

Related: Cancer of the Esophagus Esophageal Cancer

Zhang L, Zhou Y, Cheng C, et al.
Genomic analyses reveal mutational signatures and frequently altered genes in esophageal squamous cell carcinoma.
Am J Hum Genet. 2015; 96(4):597-611 [PubMed] Article available free on PMC after 02/10/2015 Related Publications
Esophageal squamous cell carcinoma (ESCC) is one of the most common cancers worldwide and the fourth most lethal cancer in China. However, although genomic studies have identified some mutations associated with ESCC, we know little of the mutational processes responsible. To identify genome-wide mutational signatures, we performed either whole-genome sequencing (WGS) or whole-exome sequencing (WES) on 104 ESCC individuals and combined our data with those of 88 previously reported samples. An APOBEC-mediated mutational signature in 47% of 192 tumors suggests that APOBEC-catalyzed deamination provides a source of DNA damage in ESCC. Moreover, PIK3CA hotspot mutations (c.1624G>A [p.Glu542Lys] and c.1633G>A [p.Glu545Lys]) were enriched in APOBEC-signature tumors, and no smoking-associated signature was observed in ESCC. In the samples analyzed by WGS, we identified focal (<100 kb) amplifications of CBX4 and CBX8. In our combined cohort, we identified frequent inactivating mutations in AJUBA, ZNF750, and PTCH1 and the chromatin-remodeling genes CREBBP and BAP1, in addition to known mutations. Functional analyses suggest roles for several genes (CBX4, CBX8, AJUBA, and ZNF750) in ESCC. Notably, high activity of hedgehog signaling and the PI3K pathway in approximately 60% of 104 ESCC tumors indicates that therapies targeting these pathways might be particularly promising strategies for ESCC. Collectively, our data provide comprehensive insights into the mutational signatures of ESCC and identify markers for early diagnosis and potential therapeutic targets.

Related: Cancer of the Esophagus Esophageal Cancer FISH Signal Transduction CREBBP gene ZNF750 BAP1

Delahaye-Sourdeix M, Anantharaman D, Timofeeva MN, et al.
A rare truncating BRCA2 variant and genetic susceptibility to upper aerodigestive tract cancer.
J Natl Cancer Inst. 2015; 107(5) [PubMed] Related Publications
Deleterious BRCA2 genetic variants markedly increase risk of developing breast cancer. A rare truncating BRCA2 genetic variant, rs11571833 (K3326X), has been associated with a 2.5-fold risk of lung squamous cell carcinoma but only a modest 26% increase in breast cancer risk. We analyzed the association between BRCA2 SNP rs11571833 and upper aerodigestive tract (UADT) cancer risk with multivariable unconditional logistic regression adjusted by sex and combinations of study and country for 5942 UADT squamous cell carcinoma case patients and 8086 control patients from nine different studies. All statistical tests were two-sided. rs11571833 was associated with UADT cancers (odds ratio = 2.53, 95% confidence interval = 1.89 to 3.38, P = 3x10(-10)) and was present in European, Latin American, and Indian populations but extremely rare in Japanese populations. The association appeared more apparent in smokers (current or former) compared with never smokers (P het = .026). A robust association between a truncating BRCA2 variant and UADT cancer risk suggests that treatment strategies orientated towards BRCA2 mutations may warrant further investigation in UADT tumors.

Feng M, Yang C, Chen X, et al.
Computed tomography number changes observed during computed tomography-guided radiation therapy for head and neck cancer.
Int J Radiat Oncol Biol Phys. 2015; 91(5):1041-7 [PubMed] Related Publications
PURPOSE: To investigate CT number (CTN) changes in gross tumor volume (GTV) and organ at risk (OAR) according to daily diagnostic-quality CT acquired during CT-guided intensity modulated radiation therapy for head and neck cancer (HNC) patients.
METHODS AND MATERIALS: Computed tomography scans acquired using a CT-on-rails during daily CT-guided intensity modulated radiation therapy for 15 patients with stage II to IVa squamous cell carcinoma of the head and neck were analyzed. The GTV, parotid glands, spinal cord, and nonspecified tissue were generated on each selected daily CT. The changes in CTN distributions and the mean and mode values were collected. Pearson analysis was used to assess the correlation between the CTN change, organ volume reduction, and delivered radiation dose.
RESULTS: Volume and CTN changes for GTV and parotid glands can be observed during radiation therapy delivery for HNC. The mean (±SD) CTNs in GTV and ipsi- and contralateral parotid glands were reduced by 6 ± 10, 8 ± 7, and 11 ± 10 Hounsfield units, respectively, for all patients studied. The mean CTN changes in both spinal cord and nonspecified tissue were almost invisible (<2 Hounsfield units). For 2 patients studied, the absolute mean CTN changes in GTV and parotid glands were strongly correlated with the dose delivered (P<.001 and P<.05, respectively). For the correlation between CTN reductions and delivered isodose bins for parotid glands, the Pearson coefficient varied from -0.98 (P<.001) in regions with low-dose bins to 0.96 (P<.001) in high-dose bins and were patient specific.
CONCLUSIONS: The CTN can be reduced in tumor and parotid glands during the course of radiation therapy for HNC. There was a fair correlation between CTN reduction and radiation doses for a subset of patients, whereas the correlation between CTN reductions and volume reductions in GTV and parotid glands were weak. More studies are needed to understand the mechanism for the radiation-induced CTN changes.

Tan T, Lim WT, Fong KW, et al.
Concurrent chemo-radiation with or without induction gemcitabine, Carboplatin, and Paclitaxel: a randomized, phase 2/3 trial in locally advanced nasopharyngeal carcinoma.
Int J Radiat Oncol Biol Phys. 2015; 91(5):952-60 [PubMed] Related Publications
PURPOSE: To compare survival, tumor control, toxicities, and quality of life of patients with locally advanced nasopharyngeal carcinoma (NPC) treated with induction chemotherapy and concurrent chemo-radiation (CCRT), against CCRT alone.
PATIENTS AND METHODS: Patients were stratified by N stage and randomized to induction GCP (3 cycles of gemcitabine 1000 mg/m(2), carboplatin area under the concentration-time-curve 2.5, and paclitaxel 70 mg/m(2) given days 1 and 8 every 21 days) followed by CCRT (radiation therapy 69.96 Gy with weekly cisplatin 40 mg/m(2)), or CCRT alone. The accrual of 172 was planned to detect a 15% difference in 5-year overall survival (OS) with a 5% significance level and 80% power.
RESULTS: Between September 2004 and August 2012, 180 patients were accrued, and 172 (GCP 86, control 86) were analyzed by intention to treat. There was no significant difference in OS (3-year OS 94.3% [GCP] vs 92.3% [control]; hazard ratio 1.05; 1-sided P=.494]), disease-free survival (hazard ratio 0.77, 95% confidence interval 0.44-1.35, P=.362), and distant metastases-free survival (hazard ratio 0.80, 95% confidence interval 0.38-1.67, P=.547) between the 2 arms. Treatment compliance in the induction phase was good, but the relative dose intensity for concurrent cisplatin was significantly lower in the GCP arm. Overall, the GCP arm had higher rates of grades 3 and 4 leukopenia (52% vs 37%) and neutropenia (24% vs 12%), but grade 3 and 4 acute radiation toxicities were not statistically different between the 2 arms. The global quality of life scores were comparable in both arms.
CONCLUSION: Induction chemotherapy with GCP before concurrent chemo-irradiation did not improve survival in locally advanced NPC.

Related: Carboplatin Cisplatin Nasopharyngeal Cancer Paclitaxel Gemcitabine

Inohara H, Takenaka Y, Yoshii T, et al.
Phase 2 study of docetaxel, cisplatin, and concurrent radiation for technically resectable stage III-IV squamous cell carcinoma of the head and neck.
Int J Radiat Oncol Biol Phys. 2015; 91(5):934-41 [PubMed] Related Publications
PURPOSE: We investigated the efficacy and safety of weekly low-dose docetaxel and cisplatin therapy concurrent with conventionally fractionated radiation in patients with technically resectable stage III-IV squamous cell carcinoma of the head and neck.
METHODS AND MATERIALS: Between March 2004 and October 2011, we enrolled 117 patients, of whom 116 were analyzable (43 had oropharyngeal cancer, 54 had hypopharyngeal cancer, and 19 had laryngeal cancer), and 85 (73%) had stage IV disease. Radiation consisted of 66 Gy in 33 fractions. Docetaxel, 10 mg/m(2), followed by cisplatin, 20 mg/m(2), administered on the same day were given once a week for 6 cycles. The primary endpoint was overall complete response (CR) rate after chemoradiation therapy. Human papillomavirus (HPV) DNA in oropharyngeal cancer was examined by PCR.
RESULTS: Of 116 patients, 82 (71%) completed treatment per protocol; 102 (88%) received the full radiation therapy dose; and 90 (78%) and 12 (10%) patients received 6 and 5 chemotherapy cycles, respectively. Overall CR rate was 71%. After median follow-up of 50.9 months (range: 15.6-113.9 months for surviving patients), 2-year and 4-year overall survival rates were 82% and 68%, respectively. Cumulative 2-year and 4-year local failure rates were 27% and 28%, respectively, whereas distant metastasis rates were 15% and 22%, respectively. HPV status in oropharyngeal cancer was not associated with treatment efficacy. Acute toxicity included grade 3 and 4 in-field mucositis in 73% and 5% of patients, respectively, whereas myelosuppression and renal injury were minimal. No patients died of toxicity. Feeding tube dependence in 8% and tracheostomy in 1% of patients were evident at 2 years postchemoradiation therapy in patients who survived without local treatment failure.
CONCLUSIONS: Local control and survival with this regimen were satisfactory. Although acute toxicity, such as mucositis, was common, late toxicity, such as laryngoesophageal dysfunction, was minimal. Therapy using weekly low-dose docetaxel and cisplatin concurrent with radiation warrants further evaluation.

Related: Cisplatin Hypopharyngeal Cancer Cancer of the Larynx Laryngeal Cancer - Molecular Biology Oropharyngeal Cancer Docetaxel

Vainshtein JM, Moon DH, Feng FY, et al.
Long-term quality of life after swallowing and salivary-sparing chemo-intensity modulated radiation therapy in survivors of human papillomavirus-related oropharyngeal cancer.
Int J Radiat Oncol Biol Phys. 2015; 91(5):925-33 [PubMed] Article available free on PMC after 01/04/2016 Related Publications
PURPOSE: To evaluate long-term health-related quality of life (HRQOL) in 2 prospective studies of chemo-intensity modulated radiation therapy (chemo-IMRT) for oropharyngeal cancer (OPC).
METHODS AND MATERIALS: Of 93 patients with stage III/IV OPC treated on prospective studies of swallowing and salivary organ-sparing chemo-IMRT, 69 were eligible for long-term HRQOL assessment. Three validated patient-reported instruments, the Head and Neck QOL (HNQOL) questionnaire, the University of Washington quality of life (UWQOL) questionnaire, and the Xerostomia Questionnaire (XQ), previously administered from baseline through 2 years in the parent studies, were readministered at long-term follow-up, along with the Short-Form 36. Long-term changes in HRQOL from before treatment and 2 years were evaluated.
RESULTS: Forty patients (58%) with a median follow-up of 6.5 years participated, 39 of whom (97.5%) had confirmed human papillomavirus-positive OPC. Long term, no clinically significant worsening was detected in mean HRQOL scores compared with 2 years, with stable or improved HRQOL from before treatment in nearly all domains. "Moderate" or greater severity problems were uncommon, reported by 5% of patients for eating, 5% for swallowing, and 2.5% and 5% by HNQOL and UWQOL summary scores, respectively. Freedom from percutaneous endoscopic gastrostomy tube dependence and stricture dilation beyond 2 years was 97.5% and 95%, respectively. Eleven percent and 14% of patients reported "moderate" or "severe" long-term worsening in HNQOL Pain and Overall Bother domains, respectively, which were associated with mean dose to the cervical esophagus, larynx, and pharyngeal constrictors.
CONCLUSIONS: At more than 6 years' median follow-up, OPC patients treated with swallowing and salivary organ-sparing chemo-IMRT reported stable or improved HRQOL in nearly all domains compared with both before treatment and 2-year follow-up. New late toxicity after 2 years was uncommon. Further emphasis on sparing the swallowing organs may yield additional HRQOL gains for long-term OPC survivors.

Related: Oropharyngeal Cancer

Pace-Balzan A, Butterworth C, Lowe D, Rogers SN
Do head and neck cancer survivors attend a high street dentist on a regular basis?
Eur J Prosthodont Restor Dent. 2014; 22(3):101-6 [PubMed] Related Publications
Head and neck cancer (HNC) patients face complex oral health issues following treatment. The aims of this study were to determine the proportion of HNC patients attending their dentist regularly and investigate clinicodemographic characteristics associated with attendance. Two surveys asked about patient attendance patterns and dentition. Pre-treatment orthopantomographs were evaluated for those treated between 2007-2009. The response rate was 66% (444/672). 69% (305/444) saw a high street dentist regularly. 28% of edentulous patients attended regularly compared with 84% with natural teeth, p < 0.001. Associations at p < 0.001 with regular attendance were the leaving of formal education (> 16 years) and earlier clinical staging. HNC patients should be encouraged to see a dentist regularly for routine dental care and cancer surveillance in partnership with the cancer service.

Related: Oral Cancer Oropharyngeal Cancer

Kao SY, Lim E
An overview of detection and screening of oral cancer in Taiwan.
Chin J Dent Res. 2015; 18(1):7-12 [PubMed] Related Publications
Oral cancer is a fatal disease, which accounts for the fourth highest incidence of malignancy in males and the seventh highest in the general population of Taiwan. About 95% of oral cancer is oral squamous cell carcinoma (OSCC). The relatively high prevalence of OSCC in Taiwan is mainly because a high-risk group of the population exists, made up of 2.5 million people and who exhibit habits of betel nut chewing as well as cigarette smoking. Unfortunately, about 50% of the new OSCC cases found in medical centers presented with TNM stage III or IV cancer lesions leading to a low 5-year survival. Therefore, it is generally accepted that the prevention and screening of OSCC at early stages or premalignant levels in the high-risk group of the population is as equally important as treatment. In this review article, we describe the current status of OSCC in Taiwan regarding epidemiology. Furthermore we research and highlight the importance of various conventional and novel methods in the detection of this disease.

Related: Oral Cancer

Raphael S, Yusuf I, Imam I
Childhood rhabdomyosarcoma in Kano, Nigeria: a retrospective analysis of 52 cases.
Niger J Med. 2015 Jan-Mar; 24(1):32-6 [PubMed] Related Publications
BACKGROUND: Rhabdomyosarcoma is the most common soft tissue sarcoma in children ≤ 15 years of age. There is, however, a paucity of reports on the pattern of its occurrence in Nigeria and other parts of Africa.
OBJECTIVE: The aim of this review is to highlight the age and sex distribution, anatomical location and morphological characteristics of rhabdomyosarcoma among children in Kano, northwestern Nigeria.
PATIENTS AND METHOD: This is a 14 year retrospective study of all cases of rhabdomyosarcomas occurring in children diagnosed at the Pathology Department of Aminu Kano Teaching Hospital, Kano, Nigeria. Clinical data obtained included sex, age, tumour site and histologic subtype.
RESULTS: Fifty two children were seen with a male to female ratio of 1 : 1.3. The ages of these Patients ranged from 4 months to 15 years with a mean (SD) age of 6.99 (4.1) years and peak age frequency in the 0 to 5 years age group. The embryonal variant was the most common histological subtype (69%). The others were alveolar (27%) and pleomorphic (4%) variants. The head and neck was the most affected region (44%) and the most common primary site was the orbit (19.2%).
CONCLUSION: Rhabdomyosarcoma is the most common childhood soft tissue sarcoma in Kano. It occurs in females more frequently than males and the most common histologic subtype is embryonal rhabdomyosarcoma affecting predominantly the orbit.

Related: Rhabdomyosarcoma

Raphael S, Mohammed AZ, Iliyasu Y
Histological pattern of thyroid gland neoplasms in Kano, Northern Nigeria.
Niger J Med. 2015 Jan-Mar; 24(1):5-11 [PubMed] Related Publications
BACKGROUND AND OBJECTIVE: Thyroid gland neoplasms occur globally with geographical variation in incidence and histopathological pattern related to age, sex, dietary and environmental factors. There is, however, no published histological study from northwestern Nigeria; hence, the need for this retrospective study to document the pattern in Kano.
MATERIALS AND METHOD: This was a retrospective study of all histologically diagnosed thyroid neoplasms in the Department of Pathology, Aminu Kano Teaching Hospital (AKTH), Kano Nigeria, over a ten year period from 1st January, 2002 to 31st December, 2011.
RESULTS: A total of 522 thyroid specimens (1.5% of all biopsies) were received over the ten year period. Thyroid neoplasms accounted for 157 (30.1%) of all the thyroid specimens, comprising 130 females (82.8%) and 27 males (17.2%) with female to male ratio of 4.8:1. The ages range from 15 to 80 years with a mean age of 35.8 years and peak occurrence in the 4th decade. There were 82 cases (52.2%) of thyroid adenoma (mostly follicular) while thyroid carcinoma accounted for 66 cases (42%). Papillary carcinoma predominated (53%) followed by follicular carcinoma (33.3%) and medullary carcinoma (9.1%). One case each (1.5%) of anaplastic carcinoma, squamous cell carcinoma and metastatic squamous cell carcinoma were seen. All the malignant tumours were epithelial and all except one were primary thyroid malignancy.
CONCLUSION: Thyroid neoplasmis a common thyroid gland lesion in Kano with a striking female preponderance. Thyroid adenoma was the most common benign neoplasm while papillary carcinoma seen a decade earlier in females was the most common malignant thyroid neoplasm. The predominance of papillary carcinoma over follicular carcinoma is a reverse of the finding of an earlier clinicopatholgical study on thyroid gland diseases in Kano.

Related: Thyroid Cancer

Wenig BM
Lymphoepithelial-like carcinomas of the head and neck.
Semin Diagn Pathol. 2015; 32(1):74-86 [PubMed] Related Publications
Lymphoepithelial-like carcinomas (LELC) of the head and neck represent malignant neoplasms that are histologically similar to nasopharyngeal carcinoma (NPC), nonkeratinizing undifferentiated type but arise in locations other than the nasopharynx. The most common location for LELC in the head and neck is the salivary glands, in particular the parotid gland. However, LELC may arise in other sites including the oropharynx (tonsils, base of tongue), sinonasal tract, larynx, and middle ear/temporal bone. Unlike the nonkeratinizing undifferentiated type of NPC which is etiologically linked to Epstein-Barr virus (EBV), LELCs are not uniformly associated with EBV. The differential diagnosis for LELC varies per site and depending on the site of occurrence may include lymphoepithelial sialadenitis, sinonasal undifferentiated carcinoma (SNUC), and large cell neuroendocrine carcinoma. Treatment general includes combined (multimodality) therapy including surgical resection, neck dissection, radiation therapy and/or chemotherapy. The prognosis may vary per site overall favorable owing to a good response to therapy.

Westra WH
The pathology of HPV-related head and neck cancer: implications for the diagnostic pathologist.
Semin Diagn Pathol. 2015; 32(1):42-53 [PubMed] Related Publications
A subset of head and neck squamous cell carcinomas are caused by the human papillomavirus (HPV). This HPV-related form of head and neck squamous cell carcinoma (HPV-HNSCC) has captured the attention of the oncology community for its rising incidence, its link to non-traditional risk factors, and its divergent clinical behavior. To diagnose this special form of head and neck squamous cell carcinoma is to provide important prognostic information and, in some instances, redirect clinical therapy. The diagnosis of HPV-HNSCC is aided by a strong appreciation for its characteristic microscopic findings and by an awareness of aberrant features that set apart a growing list of HPV-HNSCC morphologic variants. This review will delineate the microscopic appearance of HPV-HNSCC, spotlight ways in which the misinterpretation of these microscopic features can lead to diagnostic confusion, offer recommendations for appropriate terminology when diagnosing HPV-HNSCC, and provide examples of specific diagnostic scenarios where HPV testing can inform the diagnostic process.

El-Mofty SK
Human papillomavirus-related head and neck squamous cell carcinoma variants.
Semin Diagn Pathol. 2015; 32(1):23-31 [PubMed] Related Publications
During the last few decades, a phenotypically distinct type of head and neck squamous cell carcinoma (SCC), which is etiologically related to human papillomavirus (HPV), has emerged, and its prevalence continues to increase. The tumors are site-specific with special predilection for the oropharynx. They are morphologically and molecularly distinct and are responsive to different types of treatment modalities, with excellent clinical outcome, in spite of early lymph node metastasis. Microscopically, the carcinomas are nonkeratinizing SCCs. More recently, other variants that are believed to be etiologically related to HPV are reported. As a result, several clinical and pathologic questions have emerged. Importantly, whether the virus is biologically active in these tumors and involved in their pathogenesis, and second, what are the clinical implications with regard to patient management and outcome in these HPV-related variants. This review is an attempt to answer some of these questions based on information derived from available yet limited number of publications. The variants to be discussed include nonkeratinizing SCC (NKSCC), NKSCC with maturation (hybrid type), keratinizing SCC (KSSC), basaloid squamous carcinoma (BSCC), undifferentiated carcinoma (UC), papillary SCC (PSCC), small cell carcinoma, adenosquamous carcinoma (AdSCC), and spindle cell (sarcomatoid) carcinoma.

Auerbach A, Aguilera NS
Epstein-Barr virus (EBV)-associated lymphoid lesions of the head and neck.
Semin Diagn Pathol. 2015; 32(1):12-22 [PubMed] Related Publications
Epstein Barr virus (EBV)-related lymphoproliferative processes occur in the head and neck ranging from reactive processes such as infectious mononucleosis to high grade malignant lymphomas. EBV is a ubiquitous herpes virus that infects more than 90% of adults worldwide, and is generally transferred though saliva. Primary infection can occur throughout life. EBV is the first virus linked to malignancies, both epithelial and lymphoid. Both T and B cell lymphomas can be associated with EBV and evidence shows that an individual's response to the acute EBV infection may be critical in the development of subsequent lymphoma. Currently, in situ hybridization for EBER is the most sensitive available test to detect EBV and should be routinely performed in lymphoproliferative lesions of the head and neck. Immunohistochemistry for EBV related proteins, such as LMP1, is much less sensitive than EBER in situ hybridization, but can help determine latency patterns of EBV infection. Although relatively rare, primary EBV-related lymphomas must be considered in the differential of atypical lymphoid proliferations in the head and neck. We present selected EBV-related disorders of the head and neck discussing etiology as well as differential diagnosis.

Aarstad HJ, Vintermyr OK, Ulvestad E, et al.
Peripheral blood monocyte and T-lymphocyte activation levels at diagnosis predict long-term survival in head and neck squamous cell carcinoma patients.
APMIS. 2015; 123(4):305-14 [PubMed] Related Publications
This study was performed to determine whether peripheral blood (PB) monocyte and/or lymphocyte activation at diagnosis were associated with long-term prognosis in patients with head and neck squamous cell carcinoma (HNSCC), and to what extent such prognostic properties relate to human papilloma virus (HPV)-associated tumor infection of the included patients. This was a long-term prospective study describing patient survival in relation to PB T lymphocyte and monocyte activation in patients observed for up to 14 years following diagnosis. Sixty-four patients from a consecutive cohort of newly diagnosed HNSCC patients along with 16 non-cancer control patients were included over a period of almost 2 years. Monocyte responsiveness was assessed at diagnosis (N = 56 HNSCC/16 non-cancer controls) by measuring net levels of spontaneous vs lipopolysaccharide-induced monocyte chemotactic protein (MCP)-1 secretion in vitro. PB T lymphocyte activation was determined (N = 58 HNSCC/16 controls) by measuring the percentage of T cells expressing CD69 by flow cytometry. Whether HPV infection or not was determined by PCR analysis on formalin fixed paraffin-embedded tumor tissue. Tumor HPV-positive patients had better prognosis than HPV-negative patients. A low net MCP-1 response in monocytes predicted increased survival (Relative risk (RR) = 2.1; Confidence interval (CI): 1.1-4.0; p < 0.05). A low percentage of CD69 positive T lymphocytes also predicted better prognosis (RR = 2.6; CI: 1.3-5.0; p = 0.005). The predictive power of MCP-1 monocyte and CD69 T lymphocyte measures were retained when adjusted for age and gender of the patients and shown to be independent of each other (N = 50 HNSCC/16 controls). The results were similar in HPV tumor-positive and -negative patients. Patients with high monocyte- and/or T lymphocyte activation status had low survival with 8% 5 year overall survival (OS) compared to 65% 5 year OS for patients with dual low activation levels (RR = 0.27; CI: 0.14-0.56; p < 0.001), mostly secondary to disease-specific survival. Both tumor HPV-positive and -negative HNSCC patients with high percentage of CD69 positive T lymphocytes and/or high monocyte MCP-1 secretion had low long-term survival. The data suggest that the general inflammatory and adaptive immune systems are independently linked to the clinical aggressiveness of both tumor HPV-negative and -positive HNSCC patients.

Diaconescu MR, Glod M, Costea I, et al.
Clinicopathological phenotype of parathyroid carcinoma: therapeutic and prognostic aftermaths.
Chirurgia (Bucur). 2015 Jan-Feb; 110(1):66-71 [PubMed] Related Publications
Parathyroid carcinomas (PC) are rare and "devastating"€ causes of hyperparathyroidism (HP), frequently discovered fortuitously,with not always doubtless pathological confirmation, and dissociate post-therapeutic outcomes and prognosis even after well-performed surgery. We herein report four PT neoplasms,three of them proving to be authentic PCs, and one an atypical parathyroid adenoma. There were three females and one male, aged 32-49 (mean 44) years. In three circumstances PC was associated with primary HP and in one case the tumor had developed on a CKD-BMD (renal HP) background. All patients presented marked clinical and biochemical phenomena related to hypercalcemia with greater intensity of renal, bone, neuromuscular and psychological signs and symptoms to which in one observation specific uremic manifestations were added. Preoperative and intraoperative diagnosis was suspected only in two cases (one of them being in fact an atypical PT adenoma), but in the other two it was established by paraffin section on histological evidence of definitive stigma of malignancy. Our little experience underlines the wide and protean range of the origins, clinical aspects, course and prognosis of PC, which adds to the difficulties of pre- and intraoperative diagnosis. Awareness of this lesion must be permanent to detect its presence in any unusual eventuality, imposing a radical en bloc resection at the initial operation, assuring the best chance of cure.

Related: Parathyroid Cancer

Witt RL, Iacocca M, Gerges F
Contemporary diagnosis and management of Warthin's tumor.
Del Med J. 2015; 87(1):13-6 [PubMed] Related Publications
OBJECTIVE: Determine if the pathophysiology of Warthin's tumor, clinical presentation, cytology, and frozen section analysis signal an opportunity for less invasive parotid surgery and reduced morbidity.
STUDY DESIGN: Retrospective review of 120 human parotidectomies identified 50 consecutive Warthin's tumors.
SETTING: Single surgeon, single institutional study.
SUBJECTS AND METHODS: Surgeon performed ultrasound guided Fine Needle Aspiration (FNA) and intra-operative frozen section with nerve integrity monitoring were used in all cases. Partial superficial parotidectomy was performed in the initial 25 patients and extracapsular dissection in the subsequent 25 patients. RESULTs: Smoking history was acknowledged in 45/50 (90 percent) of patients. The mean age was 63. Lower parotid pain and cellulitis occurred 23/50 (46 percent) and 11/50 (22 percent), respectively. Tumor in the lower parotid pole occurred in 48/50 (96 percent). Frozen section diagnosis for Warthin's tumor was confirmed by final pathology in all 50/50 (100 percent) patients. Two of 50 patients (8 percent) in the partial superficial parotidectomy group and no patient in the extracapsular dissection group had transient facial nerve dysfunction (p > 0.05).
CONCLUSIONS: Warthin's tumor presents with a high rate of symptomatic inflammation, overwhelmingly in the lower parotid pole. Cytology largely excludes malignancy. Frozen section analysis diagnosing Warthin's tumor is highly specific in predicting final diagnosis. Minimally invasive approaches can be performed with confidence with extracapsular dissection or partial superficial parotidectomy resulting in potentially reduced morbidity.

Collins B, Smith C, Anderson M, et al.
Head and neck skin cancer in the immunocompromised patient: a quantitative analysis.
J Okla State Med Assoc. 2015; 108(1):8-12 [PubMed] Related Publications
BACKGROUND: Non-melanoma skin cancers (NMSC) are especially prone to develop in the immunosuppressed population. There is insufficient data regarding outcomes and mortality for immunosuppressed individuals with NMSC of the head and neck.
CLINICAL QUESTION: What are the mortality indicators for immunosuppressed subjects with head and neck NMSC?
METHODS: This retrospective chart review analyzes all immunosuppressed patients diagnosed with any stage NMSC at an academic tertiary care institution from 2006-2011.
RESULTS: Thirty four patients are analyzed. Odds of mortality is significantly increased for patients who required multiple surgeries (adjusted odds ratio (aOR)=23.98, 95%CI=(1.411, 407.599)) and those who were immunocompromised secondary to leukemia (aOR=28.27, 95%CI=(1.838, 434.73)).
CONCLUSION: Patients with leukemia and NMSC may have an increased risk of mortality compared to other immunocompromised patients with NMSC. Immunocompromised patients with NMSC may have a worse prognosis if multiple surgeries are required. Knowledge of mortality indicators may aid in the management of these immunocompromised patients.

Related: Basal Cell Carcinoma

Ozawa H, Imanishi Y, Ito F, et al.
PiCO2 monitoring of transferred jejunum perfusion using an air tonometry technique after hypopharyngeal cancer surgery.
Medicine (Baltimore). 2015; 94(11):e632 [PubMed] Related Publications
This study aimed to investigate the usefulness of intraluminal PCO2 (PiCO2) monitoring by air tonometry for the assessment of the vascular condition of the transferred jejunum after surgery for hypopharyngeal cancer.PiCO2 in the transplanted jejunum of 24 patients was monitored using air tonometry after radical surgery for hypopharyngeal cancer from 2003 to 2010.All but 1 patient, who removed the catheter before monitoring began, were monitored safely. PiCO2 in the transferred jejunum correlated with arterial PCO2 (PaCO2) that was measured concurrently, and dissociation of PiCO2 from PaCO2 was observed in cases with vascular complication. In those cases without postoperative vascular complication, the PiCO2 value gradually increased for 3 hours but then decreased by 12 hours after surgery. Three patients experienced major vascular complication. All 3 patients had continuous elevation of PiCO2 >100 mm Hg, although vascular flow in 1 patient recovered by removal of a venous thrombosis and reanastomosis of the vein 7.5 hours after surgery. Four other patients who experienced elevation of PiCO2 had their skin suture released for decompression of their neck wound, resulting in a decrease in PiCO2 after treatment.The current results demonstrated that continuous monitoring of PiCO2 by air tonometry accurately reflects the vascular condition of the transferred jejunum, and this method is one of the best options for postoperative monitoring of jejunum blood perfusion.

Related: Hypopharyngeal Cancer

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